Safety of a fixed-dose combination of fenofibrate/pravastatin 160 mg/40 mg in patients with mixed hyperlipidaemia: A pooled analysis from a database of clinical trials

Michel Farnier, David Marcereuil, Sophie De Niet, Jean Ducobu, Armin Steinmetz, Kjetil Retterstøl, Leszek Bryniarski, A. Császár, Francis Vanderbist

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Abstract

Background: Fenofibrate can be prescribed concomitantly with an HMGCoA reductase inhibitor (statin) to improve achievement of lipid goals in patients with atherogenic mixed hyperlipidaemia. However, some safety concerns, particularly an increased risk of myopathy, have been reported when these drugs are taken together. Objective: The aim of this analysis was to assess the general safety and tolerability of a fenofibrate/pravastatin (FF/PRA) 160mg/40 mg fixed-dose combination (FDC) capsule based on a pooled database of phase III clinical trials in patients with mixed hyperlipidaemia. Methods: Safety data were pooled from five phase III studies (four doubleblind with an uncontrolled extension and one open) of ≥12 to 64 weeks' duration. Adverse event (AE) profiles of FF/PRA 160mg/40mg (n = 645 in the double-blind cohort) were evaluated relative to comparators (statins, n = 519 or fenofibrate, n = 122). Absolute incidence rates were calculated in both the double-blind cohort and the all-studies cohort (FF/PRA 160mg/40 mg, n = 1566) for all AEs, drug-related AEs, serious AEs, discontinuations due to AEs, AEs of specific interest including abnormal laboratory data, and deaths. Results: The frequency and/or intensity of overall AEs, drug-related AEs, serious AEs and discontinuations due to AEs were not significantly increased for the FDC (36.0%, 12.3%, 1.7% and 5.1%, respectively) versus the statin (28.7%, 8.9%, 0.8% and 2.7%, respectively) and fenofibrate (59.0%, 21.3%, 0% and 4.9%, respectively) monotherapies. No deaths were reported during the course of treatment in clinical trials. Nevertheless, three deaths were reported more than 30 days after the patients completed the study; none of these deaths were assessed as being related to FF/PRA 160mg/40 mg treatment. Among the AEs of special interest, no myopathy or rhabdomyolysis were reported; no patients were considered to have experienced a druginduced liver injury; no case of pancreatitis occurred in the double-blind cohort and four patients reported pancreatitis in the all-studies cohort, two of them being study-treatment related; no case of pulmonary embolism was reported in the double-blind cohort and two patients presented with pulmonary embolism, unrelated to the study drug, in the all-studies cohort; there were more cases of decreased creatinine clearance in the FF/PRA 160mg/40mg group (1.7%) than in the statin group (0.6%). Conclusion: Within the limitations of this database (notably low percentage of very elderly patients, limited sample size of patients with mild renal insufficiency, and mode of selection in the clinical trials), no particular safety concern was raised with FF/PRA 160mg/40 mg in the double-blind cohort as compared with statin and fenofibrate monotherapies. The acceptable long-term safety profile of FF/PRA 160mg/40mg was confirmed with a low frequency of AEs of interest, comparable to that observed in the 12-week double-blind cohort. Emergent effects possibly related to FF/PRA 160mg/40mg were mainly those attributable to fenofibrate (decrease in creatinine clearance and pancreatitis).

Original languageEnglish
Pages (from-to)281-291
Number of pages11
JournalClinical Drug Investigation
Volume32
Issue number4
DOIs
Publication statusPublished - 2012

Fingerprint

Fenofibrate
Pravastatin
Hyperlipidemias
Clinical Trials
Databases
Safety
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Pancreatitis
Cohort Studies
Muscular Diseases
Pulmonary Embolism
Pharmaceutical Preparations
Creatinine
Phase III Clinical Trials
Rhabdomyolysis
Sample Size
Capsules
Renal Insufficiency

Keywords

  • fenofibrate
  • hyperlipidaemia
  • pravastatin

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Safety of a fixed-dose combination of fenofibrate/pravastatin 160 mg/40 mg in patients with mixed hyperlipidaemia : A pooled analysis from a database of clinical trials. / Farnier, Michel; Marcereuil, David; De Niet, Sophie; Ducobu, Jean; Steinmetz, Armin; Retterstøl, Kjetil; Bryniarski, Leszek; Császár, A.; Vanderbist, Francis.

In: Clinical Drug Investigation, Vol. 32, No. 4, 2012, p. 281-291.

Research output: Contribution to journalArticle

Farnier, Michel ; Marcereuil, David ; De Niet, Sophie ; Ducobu, Jean ; Steinmetz, Armin ; Retterstøl, Kjetil ; Bryniarski, Leszek ; Császár, A. ; Vanderbist, Francis. / Safety of a fixed-dose combination of fenofibrate/pravastatin 160 mg/40 mg in patients with mixed hyperlipidaemia : A pooled analysis from a database of clinical trials. In: Clinical Drug Investigation. 2012 ; Vol. 32, No. 4. pp. 281-291.
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abstract = "Background: Fenofibrate can be prescribed concomitantly with an HMGCoA reductase inhibitor (statin) to improve achievement of lipid goals in patients with atherogenic mixed hyperlipidaemia. However, some safety concerns, particularly an increased risk of myopathy, have been reported when these drugs are taken together. Objective: The aim of this analysis was to assess the general safety and tolerability of a fenofibrate/pravastatin (FF/PRA) 160mg/40 mg fixed-dose combination (FDC) capsule based on a pooled database of phase III clinical trials in patients with mixed hyperlipidaemia. Methods: Safety data were pooled from five phase III studies (four doubleblind with an uncontrolled extension and one open) of ≥12 to 64 weeks' duration. Adverse event (AE) profiles of FF/PRA 160mg/40mg (n = 645 in the double-blind cohort) were evaluated relative to comparators (statins, n = 519 or fenofibrate, n = 122). Absolute incidence rates were calculated in both the double-blind cohort and the all-studies cohort (FF/PRA 160mg/40 mg, n = 1566) for all AEs, drug-related AEs, serious AEs, discontinuations due to AEs, AEs of specific interest including abnormal laboratory data, and deaths. Results: The frequency and/or intensity of overall AEs, drug-related AEs, serious AEs and discontinuations due to AEs were not significantly increased for the FDC (36.0{\%}, 12.3{\%}, 1.7{\%} and 5.1{\%}, respectively) versus the statin (28.7{\%}, 8.9{\%}, 0.8{\%} and 2.7{\%}, respectively) and fenofibrate (59.0{\%}, 21.3{\%}, 0{\%} and 4.9{\%}, respectively) monotherapies. No deaths were reported during the course of treatment in clinical trials. Nevertheless, three deaths were reported more than 30 days after the patients completed the study; none of these deaths were assessed as being related to FF/PRA 160mg/40 mg treatment. Among the AEs of special interest, no myopathy or rhabdomyolysis were reported; no patients were considered to have experienced a druginduced liver injury; no case of pancreatitis occurred in the double-blind cohort and four patients reported pancreatitis in the all-studies cohort, two of them being study-treatment related; no case of pulmonary embolism was reported in the double-blind cohort and two patients presented with pulmonary embolism, unrelated to the study drug, in the all-studies cohort; there were more cases of decreased creatinine clearance in the FF/PRA 160mg/40mg group (1.7{\%}) than in the statin group (0.6{\%}). Conclusion: Within the limitations of this database (notably low percentage of very elderly patients, limited sample size of patients with mild renal insufficiency, and mode of selection in the clinical trials), no particular safety concern was raised with FF/PRA 160mg/40 mg in the double-blind cohort as compared with statin and fenofibrate monotherapies. The acceptable long-term safety profile of FF/PRA 160mg/40mg was confirmed with a low frequency of AEs of interest, comparable to that observed in the 12-week double-blind cohort. Emergent effects possibly related to FF/PRA 160mg/40mg were mainly those attributable to fenofibrate (decrease in creatinine clearance and pancreatitis).",
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T1 - Safety of a fixed-dose combination of fenofibrate/pravastatin 160 mg/40 mg in patients with mixed hyperlipidaemia

T2 - A pooled analysis from a database of clinical trials

AU - Farnier, Michel

AU - Marcereuil, David

AU - De Niet, Sophie

AU - Ducobu, Jean

AU - Steinmetz, Armin

AU - Retterstøl, Kjetil

AU - Bryniarski, Leszek

AU - Császár, A.

AU - Vanderbist, Francis

PY - 2012

Y1 - 2012

N2 - Background: Fenofibrate can be prescribed concomitantly with an HMGCoA reductase inhibitor (statin) to improve achievement of lipid goals in patients with atherogenic mixed hyperlipidaemia. However, some safety concerns, particularly an increased risk of myopathy, have been reported when these drugs are taken together. Objective: The aim of this analysis was to assess the general safety and tolerability of a fenofibrate/pravastatin (FF/PRA) 160mg/40 mg fixed-dose combination (FDC) capsule based on a pooled database of phase III clinical trials in patients with mixed hyperlipidaemia. Methods: Safety data were pooled from five phase III studies (four doubleblind with an uncontrolled extension and one open) of ≥12 to 64 weeks' duration. Adverse event (AE) profiles of FF/PRA 160mg/40mg (n = 645 in the double-blind cohort) were evaluated relative to comparators (statins, n = 519 or fenofibrate, n = 122). Absolute incidence rates were calculated in both the double-blind cohort and the all-studies cohort (FF/PRA 160mg/40 mg, n = 1566) for all AEs, drug-related AEs, serious AEs, discontinuations due to AEs, AEs of specific interest including abnormal laboratory data, and deaths. Results: The frequency and/or intensity of overall AEs, drug-related AEs, serious AEs and discontinuations due to AEs were not significantly increased for the FDC (36.0%, 12.3%, 1.7% and 5.1%, respectively) versus the statin (28.7%, 8.9%, 0.8% and 2.7%, respectively) and fenofibrate (59.0%, 21.3%, 0% and 4.9%, respectively) monotherapies. No deaths were reported during the course of treatment in clinical trials. Nevertheless, three deaths were reported more than 30 days after the patients completed the study; none of these deaths were assessed as being related to FF/PRA 160mg/40 mg treatment. Among the AEs of special interest, no myopathy or rhabdomyolysis were reported; no patients were considered to have experienced a druginduced liver injury; no case of pancreatitis occurred in the double-blind cohort and four patients reported pancreatitis in the all-studies cohort, two of them being study-treatment related; no case of pulmonary embolism was reported in the double-blind cohort and two patients presented with pulmonary embolism, unrelated to the study drug, in the all-studies cohort; there were more cases of decreased creatinine clearance in the FF/PRA 160mg/40mg group (1.7%) than in the statin group (0.6%). Conclusion: Within the limitations of this database (notably low percentage of very elderly patients, limited sample size of patients with mild renal insufficiency, and mode of selection in the clinical trials), no particular safety concern was raised with FF/PRA 160mg/40 mg in the double-blind cohort as compared with statin and fenofibrate monotherapies. The acceptable long-term safety profile of FF/PRA 160mg/40mg was confirmed with a low frequency of AEs of interest, comparable to that observed in the 12-week double-blind cohort. Emergent effects possibly related to FF/PRA 160mg/40mg were mainly those attributable to fenofibrate (decrease in creatinine clearance and pancreatitis).

AB - Background: Fenofibrate can be prescribed concomitantly with an HMGCoA reductase inhibitor (statin) to improve achievement of lipid goals in patients with atherogenic mixed hyperlipidaemia. However, some safety concerns, particularly an increased risk of myopathy, have been reported when these drugs are taken together. Objective: The aim of this analysis was to assess the general safety and tolerability of a fenofibrate/pravastatin (FF/PRA) 160mg/40 mg fixed-dose combination (FDC) capsule based on a pooled database of phase III clinical trials in patients with mixed hyperlipidaemia. Methods: Safety data were pooled from five phase III studies (four doubleblind with an uncontrolled extension and one open) of ≥12 to 64 weeks' duration. Adverse event (AE) profiles of FF/PRA 160mg/40mg (n = 645 in the double-blind cohort) were evaluated relative to comparators (statins, n = 519 or fenofibrate, n = 122). Absolute incidence rates were calculated in both the double-blind cohort and the all-studies cohort (FF/PRA 160mg/40 mg, n = 1566) for all AEs, drug-related AEs, serious AEs, discontinuations due to AEs, AEs of specific interest including abnormal laboratory data, and deaths. Results: The frequency and/or intensity of overall AEs, drug-related AEs, serious AEs and discontinuations due to AEs were not significantly increased for the FDC (36.0%, 12.3%, 1.7% and 5.1%, respectively) versus the statin (28.7%, 8.9%, 0.8% and 2.7%, respectively) and fenofibrate (59.0%, 21.3%, 0% and 4.9%, respectively) monotherapies. No deaths were reported during the course of treatment in clinical trials. Nevertheless, three deaths were reported more than 30 days after the patients completed the study; none of these deaths were assessed as being related to FF/PRA 160mg/40 mg treatment. Among the AEs of special interest, no myopathy or rhabdomyolysis were reported; no patients were considered to have experienced a druginduced liver injury; no case of pancreatitis occurred in the double-blind cohort and four patients reported pancreatitis in the all-studies cohort, two of them being study-treatment related; no case of pulmonary embolism was reported in the double-blind cohort and two patients presented with pulmonary embolism, unrelated to the study drug, in the all-studies cohort; there were more cases of decreased creatinine clearance in the FF/PRA 160mg/40mg group (1.7%) than in the statin group (0.6%). Conclusion: Within the limitations of this database (notably low percentage of very elderly patients, limited sample size of patients with mild renal insufficiency, and mode of selection in the clinical trials), no particular safety concern was raised with FF/PRA 160mg/40 mg in the double-blind cohort as compared with statin and fenofibrate monotherapies. The acceptable long-term safety profile of FF/PRA 160mg/40mg was confirmed with a low frequency of AEs of interest, comparable to that observed in the 12-week double-blind cohort. Emergent effects possibly related to FF/PRA 160mg/40mg were mainly those attributable to fenofibrate (decrease in creatinine clearance and pancreatitis).

KW - fenofibrate

KW - hyperlipidaemia

KW - pravastatin

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